Objective:Overweight and obesity prevalence has increased in low-income countries.This study systematically reviewed the obesity trend,disparities,and prevention and control efforts in Nepal. Methods:We searched PubMed and Google Scholar for articles and reports published between January 1,2004 and December 31,2022.Additional information on National policies and programs related to obesity prevention was retrieved from governmental websites and consultation with relevant experts.Overweight and obesity were defined using the World Health Organization body mass index cut points.Thirty-two studies and reports were included. Results:Overall,overweight and obesity rates increased in all groups in Nepal although nationally representative data remained limited.The combined overweight and obesity(OW/OB)and obesity rates in women aged 15-49 years increased from 8.5％to 22.2％and from 0.9％to 5.1％between 2006 and 2016,respectively.OW/OB and obesity rates in men were 17.1％and 2.5％based on data from the 2016 Demographic and Health Survey.OW/OB rate in under-five children increased from 0.6％to 2.8％between 2006 and 2016.Obesity rates for school-age(5-9 years)boys and girls in 2016 were 2.4％and 2.8％,respectively,and were 1.1％and 1.4％for male and female adolescents aged 10-19 years,respectively.OW/OB prevalence was much higher among women,residents in urban areas and central provinces,and in higher socioeconomic status groups.Projected prevalence of OW/OB and obesity for 2030 in adults aged 15-49 was 44.7％and 8.3％,respectively,while it was 2.2％for OW/OB in preschool children.Policies and direct interventions that specifically focused on obesity prevention and control are limited. Conclusions:OW/OB prevalence in Nepal has increased during the past 1.8 decades,disproportionately affecting population groups.Existing interventions mostly focused on undernutrition with some indirect implications for obesity prevention.In the future,Nepal needs to develop population-based programs for obesity prevention.

Background::Histological healing is closely associated with improved long-term clinical outcomes and lowered relapses in patients with ulcerative colitis (UC). Here, we developed a novel diagnostic criterion for assessing histological healing in UC patients.Methods::We conducted a retrospective cohort study in UC patients, whose treatment was iteratively optimized to achieve mucosal healing at Shanghai Tenth People’s Hospital of Tongji University from January 2017 to May 2022. We identified an inflammatory cell enumeration index (ICEI) for assessing histological healing based on the proportions of eosinophils, CD177 + neutrophils, and CD40L + T cells in the colonic lamina propria under high power field (HPF), and the outcomes (risks of symptomatic relapses) of achieving histological remission vs. persistent histological inflammation using Kaplan-Meier curves. Intrareader reliability and inter-reader reliability were evaluated by each reader. The relationships to the changes in the Nancy index and the Geboes score were also assessed for responsiveness. The ICEI was further validated in a new cohort of UC patients from other nine university hospitals. Results::We developed an ICEI for clinical diagnosis of histological healing, i.e., Y = 1.701X 1 + 0.758X 2 + 1.347X 3 - 7.745 (X 1, X 2, and X 3 represent the proportions of CD177 + neutrophils, eosinophils, and CD40L + T cells, respectively, in the colonic lamina propria under HPF). The receiver operating characteristics curve (ROC) analysis revealed that Y <-0.391 was the cutoff value for the diagnosis of histological healing and that an area under the curve (AUC) was 0.942 (95% confidence interval [CI]: 0.905-0.979) with a sensitivity of 92.5% and a specificity of 83.6% ( P <0.001). The intraclass correlation coefficient (ICC) for the intrareader reliability was 0.855 (95% CI: 0.781-0.909), and ICEI had good inter-reader reliability of 0.832 (95% CI: 0.748-0.894). During an 18-month follow-up, patients with histological healing had a substantially better outcome compared with those with unachieved histological healing ( P <0.001) using ICEI. During a 12-month follow-up from other nine hospitals, patients with histological healing also had a lower risk of relapse than patients with unachieved histological healing. Conclusions::ICEI can be used to predict histological healing and identify patients with a risk of relapse 12 months and 18 months after clinical therapy. Therefore, ICEI provides a promising, simplified approach to monitor histological healing and to predict the prognosis of UC.Registration::Chinese Clinical Trial Registry, No. ChiCTR2300077792.

Objective:To investigate the association of osteosarcopenia with falls, risk of fracture, malnutrition among middle-aged and elderly adults.Methods:A total of 253 participants dwelling in Guangzhou community aged 40-90 years were included in this cross-sectional study from December 2017 to December 2019.Bone mineral density(BMD)was detected by dual-energy X-ray absorptiometry(DEXA). Body composition was analyzed by a bioelectrical impedance analysis.Handgrip strength and gait speed were examined.The 10-year probability of a major osteoporotic fracture and hip fracture were evaluated by online WHO fracture risk assessment tool( FRAX?). Results:According to diagnostic criteria of AWGS and EWGSOP2, the incidences of osteosarcopenia varied from 5.1% to 7.6%, 5.1% to 11.4% respectively.After the adjustment for age and gender, Logistic regression analysis showed that osteosarcopenia was correlated with falls, risk of fracture and malnutrition.Osteosarcopenia definited by AWGS criteria was strongly correlated with falls( OR=3.27-5.68, P<0.05), osteosarcopenia definited by non-severe sarcopenia criteria was strongly correlated with the risk of hip fracture( OR=1.14-1.15, P<0.05), and fat-free mass index was strongly correlated with osteosarcopenia with different definitions( OR=0.21-0.48, P<0.05). Conclusions:Osteosarcopenia is associated with higher risk of falls, fracture and malnutrition in the Guangzhou community-dwelling middle-aged and elderly adults, and fat-free mass index is an independent risk factor for osteosarcopenia.

Objective To investigate the potential dosimetric advantages of half jaw volumetric modulated arc therapy ( H-VMAT) applied to the Oropharyngeal Cancer, comparing with full jaw VMAT (F-VMAT) and intensity modulated radiotherapy ( IMRT ). Methods Planning CT images of 10 oropharyngeal cancer patients were retrospectively chosen and transferred to Eclipse treatment planning system v. 11. 0 (Varian Medical Systems, Pala Alto, USA), based on which H-VMAT, W-VMAT, and IMRT plans were created. Two full arcs (360°) were adopted for VMAT planning, and the 7 beams were equally distributed for IMRT planning. The optimization constraints remained the same for the three kinds of plans. The dosimetric parameters such as D2 , D98 , D50 , HI, and CI were evaluated for PGTV, PCTV1, PCTV2, PGTVln, and PCTVln. In addition, the maximum dose (Dmax) and D1 cc(minimum dose received by 1cc) of the brainstem and spinal cord were analyzed respectively. The mean dose ( Dmean ) to the parotids, oral cave, larynx, and cervical normal tissues were also reviewed. The monitor units ( MU) for all treatment plans were recorded. Results Comparisons of the three planning techniques showed that H-VAMT improved the HI and CI of the targets (except PCTV2) significantly (HI: F =3. 959, 6. 764, 10. 581, 6. 770, 13. 040, P<0. 05;CI:F=6. 594, 4. 138, 0. 842, 4. 031, 5. 388, P<0. 05);reduced Dmax(F=4. 509, 20. 331, P<0. 05) and D1 cc for brainstem and spinal cord (F=27. 432, 26. 314, P<0. 05) significantly;reduced Dmean(F=4. 279, 29. 498, 19. 295, P<0. 05) to the normal tissues of the mouth, throat and neck significantly. The V50 of the mouth and throat were slightly lower in IMRT plans (F=8. 140, P<0. 05). IMRT was slightly better than W-VMAT in sparing oral cavity and larynx, but the dose distribution was the worst. The H-VMAT plans showed the best dose distribution in the cervical normal tissues, especially for the lower and posterior parts, where IMRT plans displayed high dose curves. Conclusions H-VMAT is dosimetrically superior than W-VMAT and IMRT for oropharyngeal cancer, which could be considered for clinical applications.

Objective To investigate the risk factors contributing to hyperlipidemia and fatty liver in pilots.Methods Two hundred and forty-six pilots received the physical examination and were asked to fill out a questionnaire.Physical examination information included height,weight,abdominal ultrasonography result and blood lipid.The questionnaire included the pilots' age,flying hours time,physical exercise amount,working pressure,sleep condition,optimistic mood status,dietary habits,nutrition knowledge awareness,smoking and drinking habit.According to the results of physical examination,the pilots with hyperlipidemia and(or) fatty liver were selected as case group,and the pilots without hyperlipidemia or fatty liver were in control group.The scores of two groups were compared.According to the caculated BMI,pilots were also divided into normal(BMI 18.5-23.9 kg/m2)overweight(BMI 24 27.9 kg/m2) obesity(BMI＞27.9 kg/m2) groups.The differences on prevalence of hyperlipidemia and fatty liver were compared among different BMI groups.Results ①There were 225 valid questionnaires out of 246 pilots and the valid rate was 91.5％.There were 60 pilots had fatty liver and the prevalence of fatty liver was 26.7％(60/225).There were 42 pilots had hyperlipidemia and the prevalence of hyperlipidemia was 18.7％ (42/225).According to the physical examination,there were 138 pilots in control group and 87 pilots in case group.②In case group,pilots' age,daily cigarette consumption and daily alcohol consumption were higher than those in control group (Z=2.008,2.934,2.153,P＜0.05).The pilots' BMI of case group were higher than that of control group (t=35.793,P＜0.05).The scores of exercise and sleep of case group were lower than those of control group (t=19.518,5.701,P＜0.05).③The detection rates of overweight and obesity in case group were higher than those in control group (x2 =16.327,13.157,P＜0.05).The prevalence differences of hyperlipidemia and fatty liver were statistically significant among different BMI groups (x2 =37.505,P＜0.05).④The smoking and drinking rates of case group were higher than those of control group (x2 =8.636,4.497,P＜0.05).Conclusions The main risk factors of hyperlipidemia and fatty liver in pilots are obesity and lack of exercise.Other factors like age,sleepquality,smoking or drinking habit have certain extent impacts on the diseases.Pilots should strengthen the physical exercise and control BMI to effectively reduce the incidence of hyperlipidemia and fatty liver in order to prolong the pilot's flying career.

Objective To investigate the risk factors contributing to hyperlipidemia and fatty liver in pilots.Methods Two hundred and forty-six pilots received the physical examination and were asked to fill out a questionnaire.Physical examination information included height,weight,abdominal ultrasonography result and blood lipid.The questionnaire included the pilots' age,flying hours time,physical exercise amount,working pressure,sleep condition,optimistic mood status,dietary habits,nutrition knowledge awareness,smoking and drinking habit.According to the results of physical examination,the pilots with hyperlipidemia and(or) fatty liver were selected as case group,and the pilots without hyperlipidemia or fatty liver were in control group.The scores of two groups were compared.According to the caculated BMI,pilots were also divided into normal(BMI 18.5-23.9 kg/m2)overweight(BMI 24 27.9 kg/m2) obesity(BMI＞27.9 kg/m2) groups.The differences on prevalence of hyperlipidemia and fatty liver were compared among different BMI groups.Results ①There were 225 valid questionnaires out of 246 pilots and the valid rate was 91.5％.There were 60 pilots had fatty liver and the prevalence of fatty liver was 26.7％(60/225).There were 42 pilots had hyperlipidemia and the prevalence of hyperlipidemia was 18.7％ (42/225).According to the physical examination,there were 138 pilots in control group and 87 pilots in case group.②In case group,pilots' age,daily cigarette consumption and daily alcohol consumption were higher than those in control group (Z=2.008,2.934,2.153,P＜0.05).The pilots' BMI of case group were higher than that of control group (t=35.793,P＜0.05).The scores of exercise and sleep of case group were lower than those of control group (t=19.518,5.701,P＜0.05).③The detection rates of overweight and obesity in case group were higher than those in control group (x2 =16.327,13.157,P＜0.05).The prevalence differences of hyperlipidemia and fatty liver were statistically significant among different BMI groups (x2 =37.505,P＜0.05).④The smoking and drinking rates of case group were higher than those of control group (x2 =8.636,4.497,P＜0.05).Conclusions The main risk factors of hyperlipidemia and fatty liver in pilots are obesity and lack of exercise.Other factors like age,sleepquality,smoking or drinking habit have certain extent impacts on the diseases.Pilots should strengthen the physical exercise and control BMI to effectively reduce the incidence of hyperlipidemia and fatty liver in order to prolong the pilot's flying career.

Objective To compare the differences and characteristics of the dose distribution of the two optimization methods in the three dimensional brachytherapy,and provide the basis for clinieal treatment.Methods Excel 2007 was used to generate random number.And a total of 21 patients of cervical cancer were selected from those who have completed the treatment.Inverse simulated annealing optimization (IPSA) plans were designed for graphical optimization (GO) plans.The dose volume histogram (DVH) parameters of the targets (V100％,V150％) and the organs (D1 cm3,D2cm3) of the two methods were analyzed.Results The targets dose of both plans could meet the prescription requirements.There was no statistically significant difference in the dose parameters of all targets (P ＞ 0.05).The closes of D1 cm3 and D2cm3 in the bladder of IPSA plan were significantly lower than that of the GO plan (t =3.596,3.490,P ＜ 0.05).There was no statistically significant difference in the dose parameters of rectum (P ＞ 0.05).Conclusions For cervix brachytherapy,the GO and IPSA have no effect on targets dose,but IPSA optimization can reduce the maximum dose of bladder.

Objective To study the FMS-like tyrosine kinase-3 (FLT3) gene, NPM1 gene and c-kit gene mutations in acute myeloid leukemia (AML) by extracting DNA from the storage of bone marrow slides, and to investigate the relationship between the three gene mutations and clinical features in AML. Methods The bone marrow slides of 55 patients diagnosed with AML were enrolled in this study. The PCR, DNA sequencing and molecular cloning were used to detect and analyse the FLT3-ITD, NPM1 and c-kit gene mutations. Patients' remission, progression and survival time were also recorded. Results The DNA was successfully extracted from the bone marrow slides with -20 ℃ frozen storage without Wright stained, chemically fixed, and room temperature storage Wright stained discoloured by phenol ∶ chloroform ∶ isoamyl alcohol method, which can be used in PCR, direct sequencing and molecular cloning sequencing analysis. 10 of the 55 cases (18.2 %) were FLT3-ITD positive, including 9 cases with heterozygous mutations and 1 case with homozygous mutation. FLT3-ITD positive group had lower complete remission (CR) rate, shorter event-free survival (EFS) time and overall survival (OS) time than the negative group (P< 0.05). 9 of the 55 cases (16.4 %) had NPM1 heterozygous gene mutations, all belonging to type A. The EFS rate of the patients with NPM1 mutation was higher in 10 months and the OS rate was higher in 19 months (P< 0.05). 3 of 9 NPM1 mutations patients were FLT3-ITD positive. The CR rates of the four groups after initial remission induction therapy in order were NPM1+FLT3-ITD-, NPM1-FLT3-ITD-, NPM1-FLT3-ITD+, NPM1+FLT3-ITD+(P<0.05). Besides, NPM1-FLT3-ITD+was a risk factor affecting the OS (RR=1.250, P=0.005). 2 of the 55 cases (3.6 %) had c-kit gene mutations, namely mutant D816H and mutant D816V. The c-kit gene mutations were not found in patients with FLT3-ITD and NPM1 mutations. Conclusions The FLT3-ITD mutation is a poor prognosis molecular marker in AML, and NPM1 mutation is a good factor for the prognosis. NPM1-FLT3-ITD+is a risk factor affecting OS. The rate of c-kit gene mutation is low in AML, without the overlap of FLT3 and NPM1 mutations.

Adult ; Cell Transformation, Neoplastic ; Craniopharyngioma ; pathology ; surgery ; Humans ; Male ; Neurosurgery ; Young Adult

OBJECTIVE: To investigate the effect of different intravenous iron treatment regimens on anemia and oxidative stress in maintenance hemodialysis (MHD) patients. METHODS: A total of 58 MHD patients were randomly divided into a multi-frequency low-dose intravenous iron group (iron sucrose 25 mg, twice a week for 8 weeks, n=19), a less-frequency regular-dose intravenous iron group (iron sucrose 100 mg, once every two weeks for 8 weeks, n=19), and a non-iron group (n=20). Another 20 healthy people served as a control group (n=20). The changes of hemoglobin (Hb), hematocrit (HCT), serum ferritin (SF) and transferrin saturation (TSAT), as well as the oxidative stress parameters of malon-dialdehyde (MDA), superoxide dismutase (SOD) and myeloperoxidase (MPO) were detected before and after the treatment. RESULTS: After 8 weeks, compared with the non-iron group, the levels of Hb, HCT, SF and TSAT in the two iron groups were significantly elevated (P<0.01), but there was no difference between the two iron groups (P>0.05). After the single dialysis, the two iron groups had higher level of serum MDA, MPO and lower level of serum SOD than that of the non-iron supplementation group (P<0.01). The multi-frequency low-dose intravenous iron group had lower level of serum MDA [(5.37 ± 0.73) nmol/mL vs (6.37±1.67) nmol/mL], MPO [(81.41±7.60) U/L vs (96.75±16.97) U/L] and higher level of serum SOD [(84.77 ± 14.02) U/mL vs (68.23 ± 4.90) U/mL] than that of the less-frequency regular-dose intravenous iron group. After 8 weeks, there was no significant difference between the two iron groups (P>0.05). CONCLUSION Multi-frequency low-dose intravenous iron can effectively improve anemia in MHD patients, whose acute oxidative stress is lower than that of less-frequency regular-dose intravenous iron, and is a relatively safe and effective intravenous iron treatment regimen.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anemia ; drug therapy ; etiology ; Female ; Ferric Compounds ; administration & dosage ; Ferric Oxide, Saccharated ; Glucaric Acid ; Humans ; Injections, Intravenous ; Kidney Failure, Chronic ; complications ; drug therapy ; Male ; Middle Aged ; Oxidative Stress ; drug effects ; Renal Dialysis ; Sucrose ; administration & dosage ; Young Adult